CHICAGO – At a time of record enrollment in Affordable Care Act (ACA) coverage, the American Medical Association (AMA) House of Delegates (HOD) adopted policy today at its Special Meeting to cover more of the nation’s uninsured. The HOD agreed that our work to further maximize coverage rates and improve coverage affordability is not yet done.

The new policy takes aim at the more than two million nonelderly uninsured with incomes below the poverty line who find themselves in the “coverage gap”— not eligible for Medicaid and not eligible for premium tax credits because they live in states that did not expand Medicaid. Building off of AMA’s support for the ACA’s Medicaid expansion, the policy advocates that any federal approach to cover uninsured individuals who fall into the coverage gap should make health insurance coverage available to these individuals at no or nominal cost, with significant cost-sharing protections. Also, states that have already implemented Medicaid expansions should be provided with additional incentives to maintain their expansions under such federal approaches.

The AMA has called for action to fix the “family glitch” (PDF) under the ACA, whereby families of workers remain ineligible for subsidized ACA marketplace coverage even though they face unaffordable premiums for coverage through employers. The new policy supports additional solutions to fix the glitch, whether it is addressed in Congress or by the Administration via administrative action. However achieved, the goal is to allow more families of workers facing unaffordable employer coverage to access subsidies to purchase ACA marketplace coverage.

“We find ourselves in a time that we can cover the remaining uninsured in this country. By closing the coverage gap, fixing the family glitch, and helping workers and their families who are facing unaffordable employer coverage, most of the nation’s uninsured will be eligible for ACA financial assistance, either the form of premium tax credits or Medicaid/CHIP. We can capitalize on this financial help available to cover the remaining uninsured,” said David H. Aizuss, M.D., a member of the AMA Board of Trustees.

The AMA also approved additional policy that would open the door to ACA marketplace coverage for undocumented immigrants and Deferred Action for Childhood Arrivals recipients, who currently are shut out of ACA marketplace coverage, even if they pay the full cost.

As outlined in AMA’s plan to cover the uninsured (PDF), the AMA already supports permanently extending the provisions included in the American Rescue Plan Act of 2021 that temporarily increased the generosity of premium tax credits to improve premium affordability and incentivize individuals eligible for tax credits eligible to get covered. Also, the AMA believes that the ARPA provision should be extended that temporarily eliminated the subsidy “cliff,” thereby expanding eligibility for premium tax credits beyond 400 percent of the federal poverty level.